Monday, April 28, 2008

Daycare cuts childhood leukemia risk by 30 percent

New analysis finds daycare attendance early in life cuts childhood leukemia risk by 30 percent

LONDON: Children who attend day care or play groups have about a 30% lower risk of developing the most common type of childhood leukaemia than those who do not, according to a new analysis of studies investigating the link.

The new research, to be presented Tuesday at the 2nd CHILDREN with LEUKAEMIA Causes and Prevention of Childhood Leukaemia Conference in London, is the first comprehensive analysis of studies investigating the association between social contact and childhood leukaemia.

“Combining the results from these studies together provided us with more confidence that the protective effect is real. Analysing the evidence in this way gives a more reliable answer to the question and a more precise estimate of the magnitude of the effect,” said the study’s leader, Dr. Patricia Buffler, professor of epidemiology at the School of Public Health of the University of California, Berkeley.

While the analysis does not reveal how intense social contact might ward off childhood leukaemia, it bolsters the theory that children exposed to common infections early in life gain protection from the disease. It is known that environments such as day care centres increase the chance of infections spreading. Some proponents of the theory believe that if the immune system is not challenged early in life and does not develop normally it may mount an inappropriate response to infections encountered later in childhood and that this could provoke the development of leukaemia.

Leukaemia is the most common cancer found in children in the industrialised world, affecting about one in 2,000 children. Incidence of the disease has been on the increase for decades. Acute lymphoblastic leukaemia, or ALL, the type of leukaemia the studies focused on, accounts for more than 80% of cases and most often occurs in children aged between 2 and 5 years. Scientists believe that for most types of childhood leukaemia to develop, there first must be a genetic mutation in the womb, followed by a second trigger during childhood that results in 1% of those children developing the disease. Infection – or the timing of infection - is one of the suspected triggers.

Buffler’s analysis included 14 published studies comprising a total of 6,108 children with leukaemia and 13,704 without the disease. Parents were asked about day care and playgroup attendance, as well as other forms of social interaction with other children. The studies varied in the timing, duration and extent of social contact investigated and in the age groups and types of leukaemia studied. Twelve of the studies found some indication of a protective effect of social interaction with other children, while two found no effect. No study found that social contact increased the risk of childhood leukaemia.

“Our analysis concluded that children who attended day care or play groups had about a 30% lower risk of developing leukaemia than those who did not. Combined results for studies of day care attendance specifically before the age of 1 or 2 showed a similarly reduced risk,” Buffler said.

The protective effect became even stronger when the researchers omitted from the analysis 5 studies in which the selection of healthy children for the comparison group relied on methods not considered optimal. In that analysis, children exposed to social contact were almost 40% less likely to go on to develop leukaemia than their counterparts.

In a separate report released at the conference on Tuesday by CHILDREN with LEUKAEMIA, scientists reviewed the evidence from studies that have investigated a link between infection and childhood leukaemia. They examined not only the idea that early life infections protect against the disease but also whether vaccination plays a role. In addition, they examined two other related areas of research: the role of infection during pregnancy and whether infection might be a factor influencing childhood leukaemia risk in situations where the population mix changes.

The report concluded that the evidence regarding whether infection during pregnancy or in situations of unusual patterns of population mixing influences the risk is inconclusive at present and that further research is necessary.

“On the question of whether infection early in life protects against leukaemia, the best evidence comes from studies of indirect measures of infection - which eliminates many of the problems common in trying to study infections directly - as well as from studies on immune system stimulation and on the genetics of immune responses,” said one of the report’s authors, Dr. Adrienne Morgan, staff scientist at CHILDREN with LEUKAEMIA.

“Putting our review together with the new analysis on social interaction, we can say pretty confidently that childcare, breastfeeding and vaccination are good things. This gives a steer to the biologists looking for what mechanisms might be at play,” she said.

Friday, April 11, 2008

Minimizing Childhood Stress

Stress overload can cause your child to be withdrawn, depressed, irritable and even suicidal. Stress is a part of everyday life for both you and your child. Some people love stress and are very productive under pressure. Others dread it and fall apart.

Strange as it may sound, stress is a necessary part of life. Without the stress of everyday things, life would get pretty boring. You and your child wouldn't have to deal with the everyday events that make you think, respond to problems and grow. Too little stress can be as bad as too much stress because constant boredom can make you feel sad and even depressed.

The key to the balancing act is stress management - so try these stress busters:
• Make sure your child eats right and gets plenty of exercise and rest
• Tell them to listen to music.
• Let them draw.
• Inspire your child to write.
• Encourage them to play with the dog.
• Allow them to talk it out. Don't force your child, but give them lots of opportunities.
• Discourage the use of tobacco, alcohol or drugs.
• Help them to replace negative thoughts with positive ones. Instead of saying, "I'm stupid," encourage your child to say, "we all make mistakes."
• Laugh together - rent a fun family film or go outdoors and have a snowball or water pistol fight.
• Encourage your school-ager or teen to start a hobby.
• Relax - lighten up their load. Does your child really need a half dozen after-school activities? Good old-fashioned play is a great stress buster.

Worried that your child may be stressed out already? If they have any of these signs, talk to your health care provider:
- Headaches, backaches, chest pain, stomachaches, indigestion, nausea or diarrhea.
- Rashes.
- Overeating or under eating.
- Sleep disturbances (too much sleep, restless sleep, difficulty falling asleep, difficulty staying asleep, waking up early).
- Twitching.
- Having trouble concentrating or with school work.
- Feeling anxious or worried.
- Feeling inadequate, frustrated, helpless or overwhelmed.
- Feeling bored or dissatisfied.
- Feeling pressured, tense, irritable, angry or hostile.
- Aggressive behavior.
- Substance abuse.
- Excessive or inappropriate crying.
- Avoiding others.

Arthritis Common in Children

Aches and pains are common in children and teens. Most of the time, they are fairly benign and dismissed as growing pains. However, musculoskeletal pains can signal several serious conditions, says Sangeeta Sule, M.D., pediatric rheumatologist at Johns Hopkins Children’s Center, including juvenile rheumatoid arthritis (JRA), the most common form of arthritis in children and teens. JRA and other rheumatologic conditions affect an estimated 294,000 American children, according to the Centers for Disease Control and Prevention.

As National Arthritis Month approaches in May, Sule and other experts at Hopkins Children’s invite coverage of the challenges in detecting and treating JRA, an autoimmune disease, in which the body mistakenly attacks its own tissues and organs, and related joint and muscle disorders in children.

“Children get arthritis, but since it’s rarely the first condition that comes to mind when a child complains of pains, substantial damage to the joints can occur before the correct diagnosis is made and treatment begins,” Sule notes.

Distinguishing harmless aches and pains from arthritis isn’t always easy. Often, JRA is a diagnosis of exclusion, and no specific test can confirm or rule it out. Several blood tests and imaging tests, such as X-rays, can help a doctor distinguish JRA from garden-variety pains.

For parents, Sule offers the following telltale signs, which should prompt a visit to the pediatrician:

• Limping
• Stiffness, swelling and redness of the joints
• Fatigue and malaise

In contrast, growing pains usually occur between the ages of 4 and 12 and cause:

• Deep aching and cramping pain in the thigh, shin or calf.
• Pain that occurs at night, often waking up the child. Growing pains are never present in the morning, which distinguishes them from rheumatic conditions, where the pain is more severe in the morning or constant throughout the day.
• Aches triggered by exercise the previous day.

Language Development Problems At Three Months

Impairments in Language Development
Can Be Detected in Infants as Young as Three Months

Speech Problems Could Be Corrected Before Child Learns to Talk

Uncover how the brains of infants distinguish differences in sounds and it may become possible to correct language problems even before children start to speak, sparing them the difficulties that come from struggling with language.
New studies conducted by Professor of Neuroscience April Benasich and her Infancy Studies Laboratory at Rutgers University in Newark are revealing new and exciting clues about how infant brains begin to acquire language and paving the way for correcting language difficulties at a time when the brain is most able to change.
Benasich and her lab were the first to determine that how efficiently a baby processes differences between rapidly occurring sounds is the best predictor of future language problems. Using methods developed by Benasich and her lab, it can be determined as early as three to six months whether a baby will struggle with language development.
Benasich’s research is now focused on uncovering in specific detail how the developing brain processes and distinguishes acoustic differences that arrive in rapid succession. The ability to differentiate those sounds, such as the difference between “ba” and “da,” is critically important because decoding language requires us to process tiny auditory differences occurring as quickly as 40 milliseconds. During the first months of life, the baby’s developing brain also is involved in constructing an acoustic map of the sounds of his or her native language. That map allows the baby to efficiently acquire language. Apparently, however, in some infants the process seems to go awry.
About 5 to 10 percent of all children beginning school are estimated to have language-learning impairments (LLI) leading to reading, speaking and comprehension problems, according to Benasich. In families with a history of LLI, 40 to 50 percent of children are likely to have a similar problem. Many of these children go on to develop dyslexia.
Using several novel methods, including dense array EEG/ERP recordings, Benasich and her lab are able to analyze EEG, ERPs and the proportion of gamma power in infant brains. The dense sensor array allows the researchers to gently measure a full range of brain activity. Those measurements are obtained by placing a soft bonnet of sensors, resembling a hairnet with lots of little sponges, on a baby’s head and then having the infant listen to different series of rapid tone sequences.
“We are finding that children who have difficulty processing rapid auditory input are not just showing a simple maturational lag, but are actually processing incoming acoustic information differently,” says Benasich.
Specifically, the research shows that babies who struggle with rapid auditory processing appear to be using different brain areas (as shown by neural patterns) and perhaps different analysis strategies to accomplish that task than children who do not have such difficulties. Included among their initial findings, the researchers have found less left hemisphere activity in the brains of children who struggle with rapid auditory processing as compared with matched control children. By pinpointing the exact differences in how the brain handles incoming acoustic information, it may become possible to guide the brains of babies at risk of developing language problems to work more efficiently before the children even begin to speak.
“We can predict with about 90 percent accuracy what a baby’s language capabilities will be just by their response to tones,” says Benasich. “Our hope now is that we will be able to gently
guide the brains of infants who are at the highest risk for language learning impairments to be more efficient processors so they can avoid the difficulties that result from struggling with language.”
To shed additional light on how inefficiencies in rapid auditory processing might be corrected, Benasich and her team have developed a Magnetic Resonance Imaging (MRI) protocol for scanning naturally sleeping healthy babies. This technique will allow better localization of active brain areas. To solve the challenge of imaging the brains of young children who typically are unable to lie still for extended periods in a scanner, Benasich’s team conducts the scans in the evening and asks the parents to go through their child’s normal bedtime routine, such as reading their infant a story, nursing them, rocking and snuggling. Once the child is asleep, headphones providing a steady stream of lullabies and an acoustic foam bonnet are placed on the baby’s head to reduce the sound of the MRI.
“Our goal is not only to develop training techniques to correct rapid auditory processing problems, but to identify the period during infant development when the brain is most “plastic,” or most able to change through learning,” explains Benasich.
The lab’s work is funded by several sources, including grants from the Solomon Center for Neurodevelopmental Research, the Don and Linda Carter Foundation, the National Institute of Child Health and Human Development, and a new $460,000 grant from the Ellison Medical Foundation.
For more information on the research being conducted by the Infancy Studies Laboratory at Rutgers University in Newark, please visit http://babylab.rutgers.edu.

Wednesday, April 9, 2008

Soy foods in puberty protects against breast cancer

Evidence is growing from animal and human studies that genistein, a potent chemical found in soy, protects against development of breast cancer - but only if consumed during puberty, says a Georgetown University Medical Center researcher in the British Journal of Cancer published online today. The challenge now, she says, is for scientists to understand precisely why soy appears to provide a shield against the most common cancer in women.

“Timing seems to be vitally important in use of this bioactive food, and if we can figure out why that is so, then we may be able to help prevent breast cancer in the widest sense possible,” says the researcher, Leena Hilakivi-Clarke, Ph.D., a professor of oncology at the Lombardi Comprehensive Cancer Center at Georgetown.

Although there are a number of tantalizing theories to explain the connection, “at the present time no convincing explanation can be offered as to why the breast cancer-risk reducing effect of genistein might be strongest during childhood and early adolescence,” she says.

Hilakivi-Clarke is a senior author of a review article published in the journal that sums up the state of knowledge concerning the role of early life genistein exposures in modifying breast cancer risk. She has long studied the link between soy use and breast cancer, as have her three co-authors, all Finnish researchers.

There have only been three human studies that tracked soy use during puberty and later breast cancer development, and two of them focused on Asian females, who eat soy in their traditional diet. But these studies suggest soy offers a very strong protective effect – a 50 percent or more reduction in the risk of breast cancer - when soy is eaten during childhood and adolescence.

The strongest evidence for genistein’s protective effect comes from studies in mice and rats, Hilakivi-Clarke says. For example, numerous studies in rats show that the data regarding prepubertal exposure to genistein are very consistent in showing a reduction in mammary cancer risk, she says. Exposure to soy in fetal development or in adult life does not have the same protective effect.

Further examination of experimental versus control rats demonstrated that use of genistein in puberty cut the number of so-called “terminal end buds” in the breast. These are the structures that lead to growth of the mammary epithelium, which are the cells lining milk ducts, etc., and it is in these epithelial cells that breast cancer originates. But Hilakivi-Clarke says it is not clear if a mere reduction in the number of these structures could reduce cancer risk, or why.

Other studies suggest that genistein controls expression of genes in terminal end buds that regulate cell growth, repair and death. For example, the chemical could be controlling the ability of stem cells, found on these buds, to reproduce themselves or to differentiate into more specialized cells. “There is evidence that suggests that the more stem cells there are on these structures, the greater the risk of breast cancer development,” she says. This evidence supports the theory that breast cancer arises from stem cells that have lost growth control.

Other associated research has found that the genes that genistein appears to activate in developing mammary glands are well known --- BRCA1, p53, and PTEN tumor suppressors, Hilakivi-Clarke says. These genes repair genetic damage and control cell survival and death, and they may also help control stem cell reproduction, she says, and genistein apparently “up-regulates” these genes, boosting production of their beneficial proteins.

What is perhaps most intriguing, she says, is that the same process that protects the breast from excess growth during pregnancy seems to be at work during puberty. “In pregnancy, BRCA1 is also up-regulated, perhaps in order to control the fate of stem cells, allowing them to make more cells for milk production, for example, but not more of themselves.”

So Hilakivi-Clarke favors the notion that genistein is acting as a breast cancer protective just as an early first pregnancy in women is known to protect against later development of the cancer:

“If malignancies occur in breast stem cells, then it is better that many of these cells are differentiated earlier rather than later. Pregnancy hormones do that, so the shorter time there is between puberty and pregnancy, the greater that protection may be,” she says. “Genistein may also help control the fate of stem cells in the same way.”

“We think this is the mechanism by which genistein works, but we really don’t know and we need to find out,” Hilakivi-Clarke says. “The findings will matter.”

Traffic exhaust = asthma, allergies, respiratory

Traffic exhaust can cause asthma, allergies and impaired respiratory function in children

Children exposed to high levels of air pollution during their first year of life run a greater risk of developing asthma, pollen allergies, and impaired respiratory function. However, genetic factors are also at play. These are the results of a new study conducted under the BAMSE project.

The BAMSE project has monitored 4,000 children in Stockholm county from birth in order to assess whether exposure to traffic pollution during their first year of life affects the risk of developing asthma and allergies. Levels of traffic exhaust were measured at the site of the home. The results show that the children who were exposed to high concentrations of pollutants ran a 60 per cent higher risk of suffering of persistent asthma symptoms. Respiratory function was also adversely affected, and the children were much more likely to be allergic to airborne allergens, particularly pollen.

Studies were also made of how the risk of developing air pollution-related allergies is influenced by genetic factors. It was found that children carrying a variant of GSTP1 (glutathione S-transferase P1) gene, which is crucial to the body’s ability to take care of air pollutants (the antioxidative system), run a greater risk of developing an allergy linked to traffic-related air pollution. According to new analyses, variants of another ‘asthma gene’, TNF (tumour necrosis factor), also affect sensitivity to air pollution. Children with a particular combination of GSTP1 and TNF variants run a considerably higher risk of developing allergies.

The children studied in the BAMSE project are now 12 years old, and an on-line follow-up survey of the children and their parents has now been launched. The answers to the survey will provide information about health, lifestyle and environmental conditions, including air pollution, during the children’s lives.

Conclusions

1. Children who grow up in Stockholm are at greater risk of developing asthma, respiratory problems and pollen allergies if they live in areas where there are high concentrations of traffic pollution.
2. Not all children who live in areas with high levels of air pollution develop allergies. Whether they do or not is partly determined by genetic factors.
3. For the first time, data are now obtained for the BAMSE project using web-based techniques, which give more reliable answers.

Omega-3 + pregnancy = cognitive & motor +'s

Omega-3 intake during last months of pregnancy boosts an infant’s cognitive and motor development

A study supervised by Université Laval researchers Gina Muckle and Éric Dewailly reveals that omega-3 intake during the last months of pregnancy boosts an infant’s sensory, cognitive, and motor development. The details of this finding are published in a recent edition of the Journal of Pediatrics.

To come to this conclusion, researchers first measured docosahexaenoic acid (DHA) concentration—a type of omega-3 fatty acid involved in the development of neurons and retinas—in the umbilical cord blood of 109 infants. “DHA concentration in the umbilical cord is a good indicator of intra-uterine exposure to omega-3s during the last trimester of pregnancy, a crucial period for the development of retinal photoreceptors and neurons,” explains Dr. Dewailly.

Tests conducted on these infants at 6 and 11 months revealed that their visual acuity as well as their cognitive and motor development were closely linked to DHA concentration in the umbilical cord blood at the time of their birth. However, there was very little relation between test results and DHA concentration in a mother’s milk among infants who were breast-fed. “These results highlight the crucial importance of prenatal exposure to omega-3s in a child’s development,” points out Dr. Muckle.

Researchers observed that DHA concentration in the umbilical cord blood was in direct relation with the concentration found in a mother’s blood, a reminder of the importance of a mother’s diet in providing omega-3 fatty acids for the fetus. They also noted that DHA concentration was higher in the fetus’s blood than in the mother’s. “While developing its nervous system, a fetus needs great quantities of DHA. It can even transform other types of omega-3s into DHA in order to develop its brain,” explains Dr. Dewailly.

For the members of the research team, there is no doubt that all pregnant women should be encouraged to get sufficient amounts of omega-3s. “A diet rich in omega-3s during pregnancy can’t be expected to solve everything, but our results show that such a diet has positive effects on a child’s sensory, cognitive, and motor development. Benefits from eating fish with low contaminant levels and high omega-3 contents, such as trout, salmon, and sardines, far outweigh potential risks even during pregnancy,” conclude the researchers.

Link between sleep disorder, behavior issues in kids

A new study by researchers at Hasbro Children’s Hospital offers a closer look at the association between childhood sleep-disordered breathing (SDB), including snoring and sleep apnea, and behavioral problems like hyperactivity and anxiety.

Published in the April issue of the Archives of Pediatric and Adolescent Medicine, the study revealed that children with SDB who are also overweight, sleep for short periods of time, or have another sleep disorder like insomnia are more likely to have behavior issues.

“It’s important for clinicians to consider the contributions of these risk factors when screening, triaging, evaluating and designing treatments for children with SDB, particularly since they can help identify those patients who are in need of aggressive interventions and close follow-up,” says lead author Judith A. Owens, M.D., M.P.H., director of the pediatric sleep disorders clinic at Hasbro Children's Hospital and an associate professor of medicine at The Warren Alpert Medical School of Brown University.

Owens and colleagues analyzed the charts of more than 230 children and adolescents between the ages of 3 and 18 years with SDB symptoms who were referred for sleep testing. They relied on each participant’s history of behavioral, emotional and academic problems as well as Child Behavior Checklist (CBCL) scores – a devise used to measure child behavior problems based on parents’ observations. Participants were also divided into three weight groups based on sex and age-adjusted norms for body mass index.

More than half of the study sample was overweight or at risk for overweight, and at least one-third (36 percent) were identified as being short sleepers. Almost half of all children had at least one additional sleep diagnosis. Forty-seven percent had a history of behavioral problems and 23 percent had a reported diagnosis of attention deficit hyperactivity disorder (ADHD).

Somewhat surprisingly, the strongest predictor of adverse behavioral outcomes and CBCL scores was the presence of at least one additional sleep diagnosis, especially insomnia – not the measure of SDB disease severity, which researchers thought would play a more significant role.

However, researchers note that the lack of association between SDB severity and behavioral outcomes does not imply that SDB doesn’t adversely affect children’s behavior. “Our results may be interpreted as suggesting that, within the spectrum of patients in this study, severity may have a relatively weaker influence on behavioral outcomes,” Owens says.

The weight group also appeared to be closely associated with poor behavioral outcomes, with the most consistent differences between the overweight and average weight groups. And as researchers predicted, a shorter mean sleep duration was associated with worse behavioral outcomes, particularly externalizing concerns.

“What we now need is a more sophisticated understanding of the nature and relative contribution of the various causes of sleep disruption that occur both as a result of, and in association with, SDB,” Owens says.

In particular, she notes that the role these risk factors play in compromising daytime alertness, and the subsequent link between decreased alertness and behavior, deserve additional research.

Tuesday, April 8, 2008

Children at Highest Risk from Obesity

A new study shows that children with obesity-related diabetes are reporting serious difficulties in making basic lifestyle changes that could save them from a lifetime of complications.

The study of 103 adolescents (ages 12 to 21) with type 2 diabetes, most of whom are overweight, shows many children and teens do not possess good self-management behaviors. The study was conducted by the Vanderbilt Diabetes Research and Training Center, working with patients at the Vanderbilt Eskind Pediatric Diabetes Clinic.

The respondents reported that making basic lifestyle changes that will lead to better future health, in areas such as diet and exercise, is more difficult than adjusting to medical management of their disease. Medical management includes daily medicines, blood sugar monitoring and injections of insulin. The study’s findings are published in the April issue of the journal Pediatrics.

“Type 2 diabetes in children is such a new problem that we don’t know a lot about these kids,” said Russell Rothman, M.D., deputy director of the Prevention and Control Division of the Vanderbilt Diabetes Research and Training Center. “This study is one of the most comprehensive to date to look at who these kids are and the challenges they and their families face trying to take care of themselves.”

Rothman and Shelagh Mulvaney, Ph.D., assistant professor in the School of Nursing, along with physicians and nurses from the Eskind Pediatric Diabetes Clinic, performed the telephone survey. Most children were either overweight or obese (possessing a body mass index (BMI) over 85 percent of the average for their age and weight).

More children (37 percent) reported the most difficult part of managing their disease was changing health habits like diet and exercise; 31 percent perceived taking insulin to be the most difficult part; and 18 percent had the toughest time adjusting to finger sticks for blood sugar tests.

More than 80 percent of patients reported taking medication regularly, and nearly 60 percent monitored their glucose twice daily. However, about 70 percent reported watching at least two hours of TV each day, and 63 percent said they did not currently participate in physical education classes. Children reported that barriers to making changes were: dealing with cravings or temptations, feeling stressed or sad, and frequently eating outside the home.

The study also found racial disparities. African-American patients had worse blood sugar control and were slightly more likely to act like adolescent peers without diabetes—such as drinking sugary drinks and eating junk foods with regularity. The reasons for the disparities are not clear, and because this was not the target of the survey, this opens up the possibility for future surveys to better understand reasons for the disparities.

“These results indicate children are having a very difficult time now, and so you might think it would be very difficult to take care of themselves long-term,” Rothman said. “This will mean a major health crisis for the country to deal with later. We owe it to ourselves, as well as to these young patients, to find better ways to help them manage their obesity and diabetes.”

Parents' behavior effects children’s slumber

Sleep, baby, sleep:

Parents who want their babies to sleep through the night would be wise to avoid co-sleeping arrangements or feeding their children evening snacks beyond early infancy. According to a Université de Montréal study published in the April issue of Archives of Pediatrics & Adolescent Medicine, the way parents put their babies to bed has a direct impact on how well children sleep when they reach four to six years old.

Some 987 mothers and fathers with five-month-old tots were recruited to answer questionnaires about their children. Parents detailed their offspring’s psychological characteristics, socio-demographic factors and sleep habits until they reached six years in age. They also recorded sleep habits or disturbances: bad dreams, total sleep time and delays in falling asleep.

“Few studies have investigated how parenting can affect sleep in children,” explained lead researcher Valérie Simard, from the Department of Psychology at the Université de Montréal and its affiliated Sacré-Coeur Hospital, who completed her study with colleagues Toré Neilsen, Richard Tremblay, Michel Boivin and Jacques Montplaisir.

The study asked parents to report on their own behavior at their child’s bedtime. For instance, whether parents lulled children to sleep, laid them down awake, or stayed with them until they slumbered. Mothers and fathers were also questioned on how they reacted to night awakenings – did they comfort children in bed, take them out of bed, give them food or bring them to the parental bed for co-sleeping"

Predictors of sleep

The researchers found that the manner 29-to-41-month-old toddlers were put to sleep influenced how they would slumber between the ages of four to six. Parenting behaviors that most affected children’s sleep included:

Giving children food or drink after they awoke, which provoked bad dreams, sleep of less than 10 hours or delays in falling back asleep.
Co-sleeping with children when they awoke delayed their falling back asleep by 15 minutes.
Staying with children at the beginning of sleep, conversely, appeared protective against delays in slumber. “Giving children food or drink – effective parenting strategies for early sleep problems – can later become inappropriate,” said Simard. “Since mothers come to believe that infants cry only when hungry, they might adopt an inappropriate response of giving food or drink when 29 to 41-month-old toddlers awake, which in turn causes bad dreams and shorter total sleep when children reach four to six years old.”

Beyond parental behavior, Simard cautions, babies can develop poor sleep patterns on their own that affect them into preschool years and beyond. “Parents often opt for co-sleeping as a reaction, but co-sleeping is not the best option to prevent future sleep difficulties. Co-sleeping and other uncommon parental behaviors have negative consequences for future sleep.”

Rise in autism is related to changes in diagnosis

Research funded by the Wellcome Trust suggests that many children diagnosed with severe language disorders in the 1980s and 1990s would today be diagnosed as having autism. The research supports the theory that the rise in the number of cases of autism may be related to changes in how it is diagnosed.

Professor Dorothy Bishop, a Wellcome Trust Principal Research Fellow at the University of Oxford, led a study which revisited 38 adults, aged between 15-31, who had been diagnosed with having developmental language disorders as children rather than being autistic. Professor Bishop and colleagues looked at whether they now met current diagnostic criteria for autistic spectrum disorders, either through reports of their childhood behaviour or on the basis of their current behaviour. The results are published this month in the journal Developmental Medicine & Child Neurology(1).

Developmental language disorders, which include specific language impairment, are diagnosed when a child has unusual difficulty in his or her grasp of the spoken language, despite normal development in other areas. This may range from a child who has very limited ability to produce or understand spoken sentences, to one who does speak in long and complex utterances, but nevertheless has problem communicating effectively because of problems in conveying a point or grasping what others mean.

Autistic spectrum disorders, which include autism and Asperger syndrome, are developmental disorders affecting how a person communicates with and relates to other people and how they make sense of the world around them.

Participants in the study were drawn from a pool of children who had participated in a series of studies of developmental language disorder conducted during the period 1986 to 2003 and about whose conditions detailed information was known. All attended special schools or classes for children with language impairments, and would have been diagnosed by educational psychologists, paediatricians or speech therapists as having developmental language disorders and none had previously been diagnosed as autistic. However, when reassessed by Professor Bishop and colleagues using current criteria, around a quarter were identified as having autistic spectrum disorder.

In recent years, the criteria for diagnosing developmental language disorders and autism have changed. This has coincided with a marked rise in the rates of diagnosis of autism. According to the Special Needs and Autism Project(2), the figure until the 1990s was widely accepted as being about 5 people per 10,000; even using the narrowest definition of autism, this rose to almost 40 in 10,000 by 2006

There are two main hypotheses to explain this rise: the "autism epidemic" hypothesis and the "diagnostic substitution" hypothesis. Whilst the former says that the rise is genuine, the latter maintains that the true prevalence of the disorder is constant but that changes in diagnostic criteria mean that more children are being diagnosed as autistic. The latter theory is supported by a UK study(3) using the General Practice Research Database, which found that the rise in autism was mirrored by a decline in frequency of language disorders, and now by Professor Bishop's study.

"Our study shows pretty direct evidence to support the theory that changes in diagnosis may contribute towards the rise in autism," says Professor Bishop. "These were children that people were saying were not autistic in the 1980s, but when we talk to their parents now about what they were like as children, it's clear that they would be classified as autistic now.

"Criteria for diagnosing autism were much more stringent in the 1980s than nowadays and a child wouldn't be classed as autistic unless he or she was very severe. Now, children are being identified who have more subtle characteristics and who could in the past easily have been missed."

However, Professor Bishop cautions against using the results to suggest that the prevalence of autism is not genuinely rising.

"We can't say that genuine cases of autism are not on the increase as the numbers in our study are very small," she says. "However, this is the only study to date where direct evidence has been found of people who would have had a different diagnosis today than they were given fifteen or twenty years ago."

Effects of Fetal Exposure Into Early Adolescence

Study Finds Effects of Fetal Exposure to Drugs, Alcohol and/or Tobacco Persist Into Early Adolescence

Although behavioral studies clearly indicate that exposure to drugs, alcohol and tobacco in utero is bad for a baby's developing brain, specific anatomic brain effects have been hard to tease out in humans. Often users don't limit themselves to one substance, and demographic factors like poverty can also influence brain development.

Now, an NIH-funded study using magnetic resonance imaging (MRI) brain scans, led by Children's Hospital Boston neurologist Michael Rivkin, MD, suggests that prenatal exposure to cocaine, alcohol, marijuana or tobacco (alone or in combination) may have effects on brain structure that persist into early adolescence. The findings, published in the April issue of Pediatrics, are of public health significance, the researchers say, since it's estimated that more than 1 million babies born annually in the United States have been exposed to at least one of these agents in utero.

Researchers at Children's and Boston Medical Center employed volumetric MRI imaging to study the brain structure of 35 young adolescents prenatally exposed to cocaine, marijuana, alcohol or tobacco. The children, who averaged 12 years old at the time of imaging, were part of part of an historic cohort of children assembled by Deborah Frank, MD at Boston Medical Center and followed there since birth. Prenatal exposures were confirmed by a combination of maternal history, urine testing of the mother or urine or meconium (stool) testing of the infants at birth.

"We found that reductions in cortical gray matter and total brain volumes were associated with prenatal exposure to cocaine, alcohol or cigarettes," says Rivkin, who is first author on the study. "Importantly, although volume reductions were associated with each of these three prenatal exposures, they were not associated with any one of these substances alone after controlling for other exposures."

Notably, the effects were found to be additive - the more substances a child was exposed to in utero, the greater the reduction in brain volume.

Rivkin notes that the study is also the first to document joint long-term neuroanatomic effects on the brain of prenatal cocaine, cigarette and alcohol exposures. Moreover, while previous studies have documented brain effects of prenatal alcohol exposure, these studies were mostly limited to children with fetal alcohol syndrome, a diagnosis that was excluded in the current study.

Although investigators initially set out to study cocaine exposure, they were struck by the finding of brain effects of prenatal tobacco exposure. "Approximately 20 percent of women who smoke continue to smoke during pregnancy," Rivkin says. "From the vantage point of preventive health care, it is important to determine the consequences on brain structure of prenatal exposure to cigarettes, alone and in combination with other substances."

Rivkin emphasizes that the number of children studied was too small to find statistically significant effects of single substances after controlling for exposure to other agents. The study was also too small to consider the effects of different levels of exposure. But the overall results are highly suggestive. "We're hopeful to be able to study the whole sample of 150 children followed at Boston Medical Center, which will permit such determinations," Rivkin says.

Both investigators concur that health care providers should offer pregnant women comprehensive care to help them reduce use of all psychoactive substances. Public health campaigns should not ignore the risks of some substances while focusing on others, as it may well be that the greater the number of total prenatal exposures, the higher the chance there will be adverse and lasting consequences for the developing brain.

PROTECT TODDLERS EYES FROM SUN’S RAYS

Protecting your children’s eyes from the sun is essential. However, babies and toddlers are often forgotten when it comes to wearing sunglasses while playing outside and vacationing. The youngest members of your family need protection from damaging ultraviolet (UV) rays, even more than you and your older children. Infants and young children are much more at risk for ultraviolet (UV) damage to the eyes, because their lenses are clearer. Their eyes do not block as many UV rays as mature eyes do. Since youngsters frequently spend most of the day outside during the warm weather, they need greater protection.

Studies show that children as young as eight can exhibit signs of serious eye damage due to the sun. Specifically, the rays damage the surface of the eye as well as the lens and retina. Over time, this can cause cataracts and retina damage that is not easily reversed.

Some baby sunglasses, for as young as six months, are made with a soft, comfortable and adjustable band and a durable polycarbonate frame. There are some that are even built right into the baby’s hat. The babies do not even know they are on!

Monday, April 7, 2008

Childhood Mental Health Problems Blight Adult Life

Mental health problems in childhood blight adult working life, suggests research published ahead of print in Occupational and Environmental Medicine. And problems in working life are associated with mid life depression and anxiety.

The findings are based on over 8000 participants of the 1958 Birth Cohort, all of whom were born during one week in March 1958, and whose health has subsequently been tracked.

Their long term mental health was reviewed during childhood at the ages of 7, 11, and 16, using information from teachers and parents, and into adulthood at the ages of 23 and 33, based on personal interviews.

At the age of 45 the participants were then invited to discuss their working lives and mental health.

Living in rented accommodation, having a longstanding illness, no qualifications, and no partner were all linked to depression and anxiety in mid life.

But so too were workplace stressors, including little control over decisions, low levels of social support, and high levels of job insecurity..

These stressors doubled to quadrupled the risk of depression and anxiety.

Internalising behaviours in early childhood and adulthood strongly predicted poor quality working life, with many work stressors.

Internalising behaviours are usually defined as depression or lack of concentration, as opposed to externalising behaviours, such as bullying and disruption.

Although mental health problems in early childhood and adulthood did not fully explain the mid life depression, these could have a knock-on effect, suggest the authors.

Mental health problems in childhood could affect the ability to pass exams and gain qualifications, so blighting an individual’s prospects of getting well paid and satisfying work.

And people who have experienced mental illness early in their lives may also opt for less demanding, low status work, because it might be more manageable, but at the same time, less rewarding and more stressful.

Click here to view the paper in full:
http://press.psprings.co.uk/oem/april/om36640.pdf

Untreated Cavities 5 Times More in Low-income Kids

About 31 percent of low-income children ages 2 to 5 have dental cavities that don't get treated, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. A much smaller portion of high-income children -- about 6 percent -- have untreated cavities.

The data come from surveys conducted between 1999 and 2004.

If untreated, the infection (dental caries) that causes tooth decay and cavities can also lead to pain, tooth loss and more serious infections. The American Academy of Pediatric Dentistry recommends a dental check-up at least twice a year for most children. Some children need more frequent dental visits because of increased risk of tooth decay, unusual growth patterns or poor oral hygiene.

AHRQ'S data also show:

• Among children from poor families, untreated cavities were more common in those age 6 to 11 (37 percent) than children 12 to 17 (27 percent).
• Likewise, among children from wealthy families, untreated cavities were more common among ages 6 to 11 (12 percent) than children 12 to 17 (7 percent).
• Only 36 percent of poor children visited a dentist in the past year compared to 70 percent of wealthy children, according to a 2004 survey.

This AHRQ News and Numbers summary is based on data from the 2007 National Healthcare Disparities Report (http://www.ahrq.gov/qual/qrdr07.htm), which examines shows disparities in Americans’ access to and quality of health care by race, ethnicity, income, and education.

Inactive Kids Face 6-fold Risk of Heart Disease

Young children who lead inactive lifestyles are five-to-six times more likely to be at serious risk of heart disease, with that degree of danger emerging as early as their teenage years, according to a new study by researchers at the University of North Carolina at Chapel Hill.

The findings, published Friday (April 4) in the open access journal Dynamic Medicine, looked at a group of children twice – first while in grade school, then again seven years later when they were in their teens.

Researchers wanted to know more about the early onset of metabolic syndrome, a condition more commonly found in adults. Metabolic syndrome is the label given to a clustering of medical disorders that raise the risk of heart disease and diabetes, such as glucose intolerance, hypertension, elevated triglycerides, low HDL (so-called “good”) cholesterol and obesity. Previous studies have found that somewhere from four percent to nine percent of adolescents have the condition.

However, until now, no one had tracked the same group of children over time to see just how fitness and activity levels in their early years played a role in the likelihood of them developing metabolic syndrome by the time they were teenagers, said Robert McMurray, professor of exercise and sports science in the department of exercise and sports science in UNC’s College of Arts and Sciences.

The study looked at data from almost 400 children between the ages of seven and 10 from across North Carolina. Researchers measured factors such as height, body mass, percentage body fat, blood pressure and cholesterol levels. Participants were also surveyed about their physical activity and given an aerobic fitness test.

When the same children were examined again seven years later, 4.6 percent had three or more characteristics of metabolic syndrome.

McMurray said adolescents with the syndrome were six times more likely to have had low aerobic fitness as children and five times more likely to have low levels of physical activity at the time they joined the study.

For example, as children, those who had low levels of physical activity got no vigorous exercise (such as playing basketball or soccer) and spent less than 20 minutes a day doing moderate-intensity physical activity (walking briskly, riding a bike at a medium speed). That means that at best, they were getting just one-third of the 60 minutes a day that is currently recommended for children by the Centers for Disease Control and Prevention, said McMurray.

“This shows efforts need to begin early in childhood to increase exercise,” he said. “Children today live a very sedentary life and are prone to obesity. This is the first study to examine the importance of childhood fitness levels on your metabolism as a teenager. Previously we didn’t know if low fitness levels were an influence.

“It’s obvious now that there is a link and this is something which we need to pay attention to by encouraging our kids to keep fit, or suffer the consequences later in life,” said McMurray.

McMurray also holds professorships in physical therapy in the department of exercise and sports science, and in the School of Public Health’s nutrition department. In addition, he coordinates the master of arts specialization in exercise physiology.

Other authors of the study were Shrikant I. Bangdiwala, research professor in the UNC School of Public Health’s biostatistics department; Joanne S. Harrell, the Frances Fox Hill professor in the School of Nursing and director of the Center for Research on Chronic Illness; and Leila D. Amorim, who at the time the paper was written was a graduate student in the School of Public Health’s biostatistics department and is now an assistant professor in the statistics department at the Federal University of Bahia in Salvador, Brazil.

The study, titled “Adolescents with metabolic syndrome have a history of low aerobic fitness and physical activity levels,” can be found at http://www.dynamic-med.com.

Pediatric Gymnastics-Related Injuries a Concern

More than 600,000 children participate in school-sponsored and club-level gymnastics competitions annually in the United States. Yet gymnastics continues to be overlooked in terms of potential for injury, while having one of the highest injury rates of all girls’ sports.

A study, conducted by researchers in the Center for Injury Research and Policy (CIRP) at The Research Institute at Nationwide Children’s Hospital and published in the April electronic issue of Pediatrics, examined data on children 6 to 17 years of age who were treated in hospital emergency departments for gymnastics-related injuries between 1990 and 2005. According to the findings, on average nearly 27,000 injuries are reported each year – nearly 426,000 injuries during the 16-year period.

“Many parents do not typically think of gymnastics as a dangerous sport,” said study senior author Lara McKenzie, PhD, MA, principal investigator in CIRP at Nationwide Children’s Hospital. “In fact, many parents consider it an activity. Yet gymnastics has the same clinical incidence of catastrophic injuries as ice hockey.”

The majority of the gymnastics injuries - 40 percent - occurred at school or a place of recreation/sports. Girls were more likely than boys to sustain upper extremity injuries, while head and neck injuries were more common in boys.

Fractures and dislocations were most common for children 6 to 11 years of age, and strains and sprains were more frequent in the 12 to 17 age group.

“Our study suggests prevention and reduction of gymnastics injuries may be achieved by the establishment and universal enforcement of rules and regulations for gymnasts, coaches and spotters,” said McKenzie, also an assistant professor at The Ohio State University College of Medicine.

Data for the study were obtained from the National Electronic Injury Surveillance System (NEISS) of the U.S. Consumer Product Safety Commission to calculate national estimates of injuries. The analysis included cases of gymnastics-related injuries treated in emergency departments across the country during the 16-year period.

Early Neglect = Aggressive Behavior in Children

Children who are neglected before their second birthday display higher levels of aggressive behavior between ages 4 and 8, according to a University of North Carolina at Chapel Hill study, published today in the journal Pediatrics.

Early child neglect may be as important as child abuse for predicting aggressive behavior, researchers say. Neglect accounts for nearly two-thirds of all child maltreatment cases reported in the United States each year, according to the Administration for Children and Families.

“The lack of attention devoted to the problem of neglect – the so-called ‘neglect of neglect’ – is a long-standing concern in the child welfare field,” said study co-author Jon Hussey, research assistant professor of maternal and child health in the UNC School of Public Health and a fellow at the Carolina Population Center. “Despite being more common than abuse, we know relatively little about the impact of neglect on children.”

More than 1,300 children from four cities and one Southern state are participating in the longitudinal study, which is coordinated by the UNC Injury Prevention Research Center (IPRC). All were known to have been maltreated or were at risk of maltreatment. They were monitored from birth through age 8. A child was considered neglected if his parents or caregivers did not provide adequate supervision or failed to meet the child’s minimum physical needs for food, clothing and shelter. Abuse was defined as either sexual or physical.

Aggression – arguing, cruelty to others, destruction of property, disobedience, threatening people and fighting or physically attacking others – was based on perceptions of the child’s primary caregiver, who was interviewed when the child was aged 4, 6 and 8.

“This isn’t the first time we’ve seen evidence suggesting that in some circumstances, neglect can be as harmful to children as abuse,” said Hussey, who published a study in Pediatrics in 2006, linking neglect to teenage violence, depression and drug use. “Understanding the consequences of early childhood neglect will help us plan programs and other interventions to benefit these children throughout their lives.”

Children with Heart Disease Risk Other Problems

Schoolchildren who required surgery as infants for congenital heart disease (CHD) run a significant risk of having problems with inattention and hyperactivity, and often require remedial services in school. “These children are at risk for academic and behavior problems, and our findings reinforce how important it is to provide them with ongoing follow-up and neurodevelopmental screening,” said study leader Amanda J. Shillingford, M.D., a pediatric cardiologist at The Children’s Hospital of Philadelphia.

The researchers, who reported their findings in the April issue of Pediatrics, studied a group of 109 children, aged five to 10, who had undergone cardiac surgery for complex congenital heart disease at Children’s Hospital when they were newborns. Of that group, 53 children--nearly half of them--were receiving remedial services at school, and 15 percent were in special education classrooms.

Based on questionnaire responses from their parents and teachers, although the majority of the children with CHD scored in the normal range, the rates of high-risk scores for inattention and hyperactivity were three to four times greater than those found in the general population.

Previous studies at The Children’s Hospital of Philadelphia and other centers found that school-aged children with complex CHD tended to have normal cognitive abilities but were at risk for problems in visual and motor skills, as well as impairments in speech, language and executive functioning (executive functioning refers to capacities for attention, planning, decision-making and problem-solving).

Each year, over 10,000 newborns in the U.S. have CHD severe enough to require surgery before they are one year of age. Advances in medical and surgical treatments have steadily improved survival rates for even the most complex conditions. One such condition is hypoplastic left heart syndrome, in which a severely underdeveloped left ventricle is unable to pump enough blood to the body. A series of three surgeries during the newborn and infant period is needed to correct this heart defect. Children with this and several other congenital heart conditions were included in the study.

“As survival rates have improved,” said Shillingford, “the important longer-term issue is quality of life for patients and their families as they reach school age and beyond. We hope our findings will help raise awareness among parents, teachers and physicians about the children’s risk of neurodevelopmental problems.” Shillingford added that a next step for researchers is to conduct larger, multicenter studies, with more formalized diagnostic tools, and to develop formalized follow-up protocols for these children. Such follow-up programs are currently being designed at Children’s Hospital.

Less Sleep, More TV Leads to Overweight Toddlers

FINDINGS
Infants and toddlers who sleep less than 12 hours a day and who watch two or more hours of television per day are twice as likely to become overweight by age 3 than children who sleep longer.

RELEVANCE
This is the first study to investigate the link between sleep and overweight in very young children.

INVESTIGATORS
Elsie Taveras, MD, Assistant Professor in the Department of Ambulatory Care and Prevention, Harvard Medical School
http://www.dacp.org/faculty_Taveras.html

Matthew Gillman, MD, Associate Professor and Director of the Obesity Prevention Program in the Department of Ambulatory Care and Prevention, Harvard Medical School
http://www.dacp.org/faculty_Gillman.html

CITATION
Archives of Pediatric and Adolescent Medicine, April 2008

Newswise — Infants and toddlers who sleep less than 12 hours a day are twice as likely to become overweight by age 3 than children who sleep longer. In addition, high levels of television viewing combined with less sleep elevates the risk, so that children who sleep less than 12 hours and who view two or more hours of television per day have a 16 percent chance of becoming overweight by age 3.

“Mounting research suggests that decreased sleep time may be more hazardous to our health than we imagined,” says Elsie Taveras, MD, assistant professor in Harvard Medical School’s Department of Ambulatory Care and Prevention and lead author on the study. “We are now learning that those hazardous effects are true even for young infants.”

Results are published in the April 2008 issue of Archives of Pediatric and Adolescent Medicine.

The study team identified 915 mother-infant pairs from Project Viva, a long-term study of the effects of diet and other lifestyle factors on maternal and child health over time. Infant weight and measurements were taken at several in-person visits up to three years of age. Mothers reported how many hours their child slept per day on average at 6 months, 1 year, and 2 years postpartum. Parents were also asked to report the average number of hours their children watched television on weekdays and weekends.

The combination of low levels of sleep and high levels of television viewing appeared to be synergistic and was associated with markedly higher BMI scores and increased odds of becoming overweight.

“Although previous studies have shown a similar link between sleep restriction and overweight in older children, adolescents, and adults, this the first study to examine the connection in very young children,” says Matthew Gillman, MD, SM, Harvard Medical School associate professor and director of the Obesity Prevention Program in the Department of Ambulatory Care and Prevention. Gillman is also the study’s senior author.

Television viewing is also a known risk factor for children becoming overweight.

These study results support efforts to reduce television viewing and to promote adequate sleep in efforts to prevent and reduce unhealthy childhood weight-gain. Children who are overweight are often at higher risk for obesity and related conditions, such as hyperlipidemia, hypertension, asthma, and type II diabetes, later in life.

“Getting enough sleep is becoming more and more difficult with TV, Internet, and video games in the rooms where children sleep,” says Dr. Taveras. “Our findings suggest that parents may wish to employ proven sleep hygiene techniques, such as removing TV from children’s bedrooms, to improve sleep quality and perhaps sleep duration.”

This study was supported by the National Institutes of Health, the Harold Amos Medical Faculty Development Program, and the Robert Wood Johnson Foundation.

Full citation:

Archives of Pediatric and Adolescent Medicine, Vol. 162, 4

“Short Sleep Duration in Infancy and Risk of Childhood Overweight”